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Related Concept Videos

Electrocardiogram Fundamentals01:28

Electrocardiogram Fundamentals

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Introduction
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
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Left Ventricular Lead Placement Guided by Reduction in QRS Area.

Mohammed Ali Ghossein1, Francesco Zanon2, Floor Salden3

  • 1Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.

Journal of Clinical Medicine
|December 24, 2021
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Summary

Reduction in QRS area after cardiac resynchronization therapy (CRT) correlates with hemodynamic improvement. This suggests QRS area can guide optimal left ventricular (LV) lead placement for better patient outcomes.

Keywords:
LV lead placementQRS areacardiac resynchronization therapyheart failureinvasive hemodynamic measurements

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Cardiac resynchronization therapy (CRT) improves outcomes, with QRS area reduction being a key indicator.
  • Optimizing left ventricular (LV) lead placement is crucial for maximizing CRT benefits.
  • Current methods for guiding LV lead placement may not fully capture hemodynamic response.

Purpose of the Study:

  • To determine if QRS area reduction is associated with hemodynamic improvement during CRT.
  • To investigate if different LV pacing sites influence hemodynamic response and QRS area.
  • To assess the utility of QRS area as a non-invasive guide for LV lead placement.

Main Methods:

  • Prospective study of 52 patients with CRT indications across three hospitals.
  • Acute hemodynamic response measured by % change in maximum rate of rise of LV pressure (%∆LVdP/dtmax).
  • Analysis of QRS area change (∆QRS area) and QRS duration change (∆QRS duration) relative to 188 LV pacing sites.

Main Results:

  • Lateral LV pacing yielded significantly greater %∆LVdP/dtmax and ∆QRS area compared to anterior/posterior sites.
  • Proximal electrode pacing also resulted in larger %∆LVdP/dtmax and ∆QRS area.
  • A strong positive correlation (median 0.76) was observed between ∆QRS area and %∆LVdP/dtmax within patients.

Conclusions:

  • Within-patient ∆QRS area strongly correlates with hemodynamic improvement (%∆LVdP/dtmax) across various LV pacing locations.
  • QRS area is an easily obtainable, objective, and non-invasive parameter.
  • QRS area shows potential as a valuable tool to guide LV lead placement in CRT.